Quality Indicator For Rehabilitative Care Research Articles

Exploring the Quality-of-Care Dynamics of Inpatient Psychosocial Rehabilitation in Community-Based Mental Health Services: A Comprehensive Analysis.

This study aims to investigate the intricacies of inpatient psychosocial rehabilitation by examining a community-based mental health inpatient rehabilitation service in Nova Scotia, Canada. It provides a comparative analysis with national standards using the Quality Indicator for Rehabilitative Care (QuIRC) and offers recommendations for improvement. The study will link findings to research on enhancing specific domains, focusing on strategies to address identified challenges and leverage opportunities to meet or exceed national benchmarks in promoting recovery and social inclusion. This study utilizes the QuIRC as a primary assessment tool to evaluate the quality of care in psychiatric and psychosocial rehabilitation care unit. The QuIRC assessment findings reveal crucial insights across several domains, including the living and therapeutic environment, treatments and interventions, self-management and autonomy, social interface, human rights, and recovery-based practices. The study identifies strengths and areas for improvement by comparing unit scores with national averages in Canada, offering a detailed examination of the quality of care provided in a community-based psychosocial rehabilitation service. Using the QuIRC identifies strengths and areas for improvement of current care provided, opening opportunities for positive change and improved quality of care. By highlighting the critical indicators of the quality of care and best practices derived from the QuIRC assessment, this study provides practical insights that can be directly applied by practitioners, policymakers, and stakeholders, fostering an understanding of essential elements that support effective mental health rehabilitation within community settings.

Three-year-cohort-study: clinical and cost effectiveness of an inpatient psychiatric rehabilitation.

There has been a resurgence of interest in psychiatric rehabilitation to cater to patients with chronic and complex mental illnesses. This study is aimed at examining patients' characteristics and the prevalence of psychiatric and non-psychiatric comorbidity in a local inpatient rehabilitation service, as well as to investigate the impact of the whole-system approach to rehabilitation on future utilization of mental health services and to analyze the cost-effectiveness and quality of this service. Patients managed over 3 years in a psychiatric rehabilitation inpatient unit were self-controlled; they were retrospectively (pre-rehabilitation) and prospectively (post-rehabilitation) examined for readmission rate, length of stay (LOS), and emergency room (ER) visits. Relevant information was retrieved from Discharge Abstract Database (DAD), Patient Registration System (STAR), and Emergency Department Information System (EDIS). The quality of care in the rehabilitation unit was examined using the Quality Indicator for Rehabilitative Care (QuIRC), and the cost analysis was conducted using data obtained from a single-payer government medical service insurance (MSI) billing system. Of the 185 patients admitted over the study period, 158 were discharged. There was a significant reduction in readmission rate (64% decrease), LOS (6,585 fewer days spent in hospital), and ER presentations (166 fewer visits) (P < 0.0001), respectively. There were substantial subsequent cost savings in the post-rehabilitation year. In the 3-year study, an inpatient psychiatric rehabilitation service in Nova Scotia, Canada, resulted in the successful discharge of most patients with severe and persistent mental illness to more socially inclusive environments. It also reduced their post-rehabilitation mental health service utilization, hence greatly enhancing the effectiveness and efficiency of these services.

Prevention and Recovery Care Services in Australia: Describing the Role and Function of Sub-Acute Recovery-Based Residential Mental Health Services in Victoria.

Background: Prevention and Recovery Care (PARC) services are relatively new sub-acute residential services that have supported people with mental ill-health in Victoria since 2003. Operated from a partnership model between non-governmental agencies and clinical mental health services, PARC services integrate intensive recovery-focused psychosocial input with clinical mental health care. Aim: To describe and contrast the 19 PARC services operating in Victoria at the time of the study, in terms of structures and function, resources, and content and quality of care. Method: Nineteen participants, one representing each PARC, completed two surveys: the first, a purpose-designed survey relating to the government guidelines for PARC services, and the second, the Quality Indicator for Rehabilitative Care. Results: Descriptive analyses highlighted that PARC services have operated in inner-city, urban, and regional areas of Victoria, from between 1 and 14 years. Participants reported that a recovery approach was at the core of service delivery, with a vast array of group and individual programs on offer. Across the state, there was variation in the quality of services according to the Quality Indicator for Rehabilitative Care domains. Conclusions: This study has identified that there is variation in the structure and function, resourcing, and content and quality of care offered across Victoria’s PARC services even though, in the main, they are guided by government guidelines. Hence it appears that the services adapt to local needs and changes in service systems occurring over time. The findings indicate emerging evidence that PARCs are providing recovery-oriented services, which offer consumers autonomy and social inclusion, and therefore likely enable a positive consumer experience. The range of individual and group programs is in line with the Victorian guidelines, offering practical assistance, therapeutic activities, and socialization opportunities consistent with consumer preferences. Further research into implementation processes and their impacts on quality of care is warranted concerning this and similar service models.

Supported accommodation for people with mental health problems: the QuEST research programme with feasibility RCT

Background Across England, around 60,000 people live in mental health supported accommodation: residential care, supported housing and floating outreach. Residential care and supported housing provide on-site support (residential care provides the highest level), whereas floating outreach staff visit people living in their own tenancies. Despite their abundance, little is known about the quality and outcomes of these services. Objectives The aim was to assess the quality, costs and effectiveness of mental health supported accommodation services in England. The objectives were (1) to adapt the Quality Indicator for Rehabilitative Care (QuIRC) and the Client Assessment of Treatment scale for use in mental health supported accommodation services; (2) to assess the quality and costs of these services in England and the proportion of people who ‘move on’ to less supported accommodation without placement breakdown (e.g. to move from residential care to supported housing or supported housing to floating outreach, or, for those receiving floating outreach, to manage with fewer hours of support); (3) to identify service and service user factors (including costs) associated with greater quality of life, autonomy and successful move-on; and (4) to carry out a feasibility trial to assess the required sample size and appropriate outcomes for a randomised evaluation of two existing models of supported accommodation. Design Objective 1 – focus groups with staff (n = 12) and service users (n = 16); psychometric testing in 52 services, repeated in 87 services (adapted QuIRC) and with 618 service users (adapted Client Assessment of Treatment scale). Objectives 2 and 3 – national survey and prospective cohort study involving 87 services (residential care, n = 22; supported housing, n = 35; floating outreach, n = 30) and 619 service users followed over 30 months; qualitative interviews with 30 staff and 30 service users. Objective 4 – individually randomised, parallel-group feasibility trial in three centres. Setting English mental health supported accommodation services. Participants Staff and users of mental health supported accomodation services. Interventions Feasibility trial involved two existing models of supported accommodation: supported housing and floating outreach. Main outcome measures Cohort study – proportion of participants who successfully moved to less supported accommodation at 30 months’ follow-up without placement breakdown. Feasibility trial – participant recruitment and withdrawal rates. Results The adapted QuIRC [QuIRC: Supported Accomodation (QuIRC-SA)] had excellent inter-rater reliability, and exploratory factor analysis confirmed its structural validity (all items loaded onto the relevant domain at the > ± 0.3 level). The adapted Client Assessment of Treatment for Supported Accommodation had good internal consistency (Cronbach’s alpha 0.89) and convergent validity (rs = 0.369; p Conclusions We did not find clear evidence on the most effective model(s) of mental health supported accommodation. Indeed, our feasibility study suggests that trials comparing effectiveness cannot be conducted in this country. A range of options are required to provide appropriate support to individuals with differing needs. Future work Future research in this field requires alternatives to trials. Service planners should be guided by the mental health needs of the local population and the pros and cons of the different services that our study identified, rather than purely financial drivers. Trial registration Current Controlled Trials ISRCTN19689576. Funding This programme was funded by the National Institute for Heath Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 7, No. 7. See the NIHR Journals Library website for further project information. The fundholders are Camden and Islington NHS Foundation Trust and the research is a collaboration between University College London, Queen Mary University of London, King’s College London, the University of Ulster and Durham University.

Prevention and Recovery Care Services in Australia: Developing a State-Wide Typology of a Subacute Residential Mental Health Service Model.

Aims: Community-based residential alternatives to hospitalization are an emerging service model. Evidence for their acceptability and effectiveness is promising but limited. Prevention and Recovery Care (PARC) services are one such residential model, offering short-term subacute treatment and care (usually between 7 and 28 days). PARC services in Victoria, Australia, are designed to support consumers with severe mental illness to either avoid a psychiatric hospital admission (step-up care) or transition from hospital back into the community (step-down care). As a precursor to a series of studies investigating the appropriateness, effectiveness and efficiency of PARC services, we aimed to investigate whether a typology of PARC services can be developed. Methods: A manager or other appropriately knowledgeable staff member from each of the 19 adult PARC services included in the study completed a tool based on PARC operational guidelines (the Victorian PARC service mapping questionnaire) and a validated instrument measuring the quality of care in residential mental health settings (the Quality Indicator for Rehabilitative Care, QuIRC). Thirty (of 42) stakeholders participated in a modified Delphi study to select 23 from the available 230 variables for entry into a hierarchical cluster analysis. Results: Cluster analysis produced three clusters of equal dissimilarity. At the 90% confidence level, there were four variables which were significantly different between clusters. These were the year the PARC was opened, the QuIRC Living Environment domain score, the proportion of all admissions that were a step-down admission from an inpatient unit, and how often families were invited to care meetings. Sensitivity analyses suggested the findings were robust to the method used to identify clusters. Conclusions: Although PARC services were broadly similar, their identified differences suggest there is variable model implementation across Victoria sufficient to generate a PARC service typology. This typology may prove important for interpreting differences in outcomes experienced by consumers and carers using PARC services, when applied in our analyses of service effectiveness. The value of conducting service mapping and typology studies is underscored. Further research to characterize subacute residential services, including recovery-promoting features of the built environment, is warranted.

Predictors of quality of care in mental health supported accommodation services in England: a multiple regression modelling study

BackgroundSpecialist mental health supported accommodation services are a key component to a graduated level of care from hospital to independently living in the community for people with complex, longer term mental health problems. However, they come at a high cost and there has been a lack of research on the quality of these services. The QuEST (Quality and Effectiveness of Supported tenancies) study, a five-year programme of research funded by the National Institute for Health Research, aimed to address this. It included the development of the first standardised quality assessment tool for supported accommodation services, the QuIRC-SA (Quality Indicator for Rehabilitative Care – Supported Accommodation). Using data collected from the QuIRC-SA, we aimed to identify potential service characteristics that were associated with quality of care.MethodsData collected from QuIRC-SAs with 150 individual services in England (28 residential care, 87 supported housing and 35 floating outreach) from four different sources were analysed using multiple regression modelling to investigate associations between service characteristics (local authority area index score, total beds/spaces, staffing intensity, percentage of male service users and service user ability) and areas of quality of care (Living Environment, Therapeutic Environment, Treatments and Interventions, Self-Management and Autonomy, Social Interface, Human Rights and Recovery Based Practice).ResultsThe local authority area in which the service is located, the service size (number of beds/places) and the usual expected length of stay were each negatively associated with up to six of the seven QuIRC-SA domains. Staffing intensity was positively associated with two domains (Therapeutic Environment and Treatments and Interventions) and negatively associated with one (Human Rights). The percentage of male service users was positively associated with one domain (Treatments and Interventions) and service user ability was not associated with any of the domains.ConclusionsThis study identified service characteristics associated with quality of care in specialist mental health supported accommodation services that can be used in the design and specification of services.

Quality of care in long-term care departments in mental health facilities across the Czech Republic.

In the region of Central and Eastern Europe, long-term departments at psychiatric hospitals provide a large proportion of the care for people with complex mental health needs. The System of United Psychiatric Rehabilitation (S.U.P.R.) project focussed on the implementation of a complex set of interventions of psychosocial rehabilitation to increase the quality of care. The aim of this study was to assess the effect of the S.U.P.R. psychosocial rehabilitation programme on the quality of care at the longer-term inpatient psychiatric departments. All 12 psychiatric hospitals in the Czech Republic were asked to participate in the study. A 'before and after' design was adopted to evaluate the impact of the S.U.P.R. programme. Quality of care was assessed using the internationally validated, web-based tool, QuIRC (Quality Indicator for Rehabilitative Care), which provides percentage scores (0-100%) on seven domains of care and an overall mean quality score. Fourteen long-term wards of 12 psychiatric hospitals for adults in the Czech Republic participated in the S.U.P.R. project. The mean total QuIRC scores were relatively low at the start of the project (range 33% to 53%) but all domain scores increased two years after the S.U.P.R. programme was implemented (range 44% to 62%). Staff feedback was generally positive about the programme, but inadequate staffing was an impediment to its success. Implementing a modern concept for psychosocial rehabilitation aimed at progressing the recovery of people with complex mental health problems can improve the quality of care in longer term inpatient settings.

A cluster randomised controlled trial of a staff-training intervention in residential units for people with long-term mental illness in Portugal: the PromQual trial.

This study aimed to assess the efficacy of a staff-training intervention to improve service users' engagement in activities and quality of care, by means of a cluster randomised controlled trial. All residential units with at least 12-h a day staff support (n=23) were invited to participate. Quality of care was assessed with the Quality Indicator for Rehabilitative Care (QuIRC) filled online by the unit's manager. Half the units (n=12) were randomly assigned to continue providing treatment as usual, and half (n=11) received a staff-training intervention that focused on skills for engaging service users in activities, with trainers working alongside staff to embed this learning in the service. The primary outcome was service users' level of activity (measured with the Time Use Diary), reassessed at 4 and 8 months. Secondary outcomes were the quality of care provided (QuIRC), and service users' quality of life (Manchester Short Assessment of Quality of Life) reassessed at 8 months. Generalized linear mixed effect models were used to assess the difference in outcomes between units in the two trial arms. The trial was registered with Current Controlled Trials (Ref NCT02366117). Knowledge acquired by the staff during the initial workshops increased significantly (p≤0.01). However, the intervention and comparison units did not differ significantly in primary and secondary outcomes at either follow-up. The intervention increased the level of knowledge of staff without leading to an improvement in service users' engagement in activities, quality of life, or quality of care in the units.

Psychiatric Rehabilitation: Quality of Care and Clinical Effectiveness

There has been a resurgence of interest in mental health rehabilitation over the past decade, as it became increasingly clear that alternative services were not able to cater for the needs of patients with chronic and complex mental health issues. The study of a cohort of 80 clients was conducted in a 40-bed-inpatient rehabilitation unit retrospectively over a 1-year period, and aimed at describing the service-users’ characteristics, source of referrals and discharge destinations, along with examining the impact of an integrated medical model with psychosocial approach on Length of Stay (LOS); and investigating the sustenance of favorite outcomes over the 6-month period following discharge. Moreover, the quality of service provision on the unit was examined using QuIRC (Quality Indicator for Rehabilitative Care). The bio-psychosocial intervention model resulted in a significant reduction of LOS (p < .0001). The majority of patients were discharged to a less restrictive environment; revolving door admissions were significantly reduced, as well as the utilization of other psychiatric services (acute inpatient, p < .0001, short stay unit, p < .0001, and emergency room for mental health reasons p < .005). The quality of care provided was well above comparable average in some domains but slightly less in others. In the current climate of outcome driven services, we have demonstrated the effectiveness of an integrated model that appears to be prospectively sustainable. Investing resources and efforts on effective psychiatric rehabilitation programs for patients with enduring mental illness and complex needs, improves quality and economics that resonates throughout the wider scope of psychiatric services.

Adaptation of the Quality Indicator for Rehabilitative Care (QuIRC) for use in mental health supported accommodation services (QuIRC-SA).

BackgroundNo standardised tools for assessing the quality of specialist mental health supported accommodation services exist. To address this, we adapted the Quality Indicator for Rehabilitative care-QuIRC-that was originally developed to assess the quality of longer term inpatient and community based mental health facilities. The QuIRC, which is completed by the service manager and gives ratings of seven domains of care, has good psychometric properties.MethodsFocus groups with staff of the three main types of supported accommodation in the UK (residential care, supported housing and floating outreach services) were carried out to identify potential amendments to the QuIRC. Additional advice was gained from consultation with three expert panels, two of which comprised service users with lived experience of mental health and supported accommodation services. The amended QuIRC (QuIRC-SA) was piloted with a manager of each of the three service types. Item response variance, inter-rater reliability and internal consistency were assessed in a random sample of 52 services. Factorial structure and discriminant validity were assessed in a larger random sample of 87 services.ResultsThe QuIRC-SA comprised 143 items of which only 18 items showed a narrow range of response and five items had poor inter-rater reliability. The tool showed good discriminant validity, with supported housing services generally scoring higher than the other two types of supported accommodation on most domains. Exploratory factor analysis showed that the QuIRC-SA items loaded onto the domains to which they had been allocated.ConclusionsThe QuIRC-SA is the first standardised tool for quality assessment of specialist mental health supported accommodation services. Its psychometric properties mean that it has potential for use in research as well as audit and quality improvement programmes. A web based application is being developed to make it more accessible which will produce a printable report for the service manager about the performance of their service, comparison data for similar services and suggestions on how to improve service quality.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0799-4) contains supplementary material, which is available to authorized users.

Quality assessment of mental health rehabilitation services

ObjectivesProviding good quality mental health care is vital to achieve better outcomes but service quality is a complex, multidimensional construct that extends beyond the delivery of specific evidence based treatments and interventions. This makes it difficult to operationalize and measure, particularly at the international level where different socioeconomic and political contexts impact. Mental health rehabilitation services focus on people with severe and complex psychosis. This group are one of the most socially excluded in society and are vulnerable to exploitation and abuse. They are also, be definition, difficult to treat and, historically, have often been institutionalised in hospital or community facilities.AimsThis presentation will report on the development and application of an internationally validated quality assessment tool for longer term mental health care facilities, the Quality Indicator for Rehabilitative Care (QuIRC).MethodsThe content of the QuIRC was derived from a systematic literature review, international Delphi exercise and review of care standards in ten European countries. Its psychometric properties were assessed in over 200 longer-term mental health facilities across Europe involving validation with over 1750 service users. It has subsequently been used in a national programme of research into inpatient mental health rehabilitation services in England which will also be briefly described.ResultsThe QuIRC has excellent inter-rater reliability and validity. Specific aspects of care assessed by the QuIRC have been found to be associated with successful community discharge from inpatient mental health rehabilitation services.ConclusionsThe QuIRC is a free to use, standardised and validated on-line international quality assessment benchmarking and research tool, available in ten European languages.Disclosure of interestThe author has not supplied his declaration of competing interest.

Living conditions and quality of care in residential units for people with long-term mental illness in Portugal--a cross-sectional study.

BackgroundAs in most European countries, mental health care has shifted from large hospitals to smaller community based settings in Portugal. Our study objectives were to determine: a) the characteristics of users of mental health residential facilities in Portugal; b) the quality of care provided comparing community and hospital units; and c) to investigate associations between quality of care, service and service users’ characteristics and experiences of care.MethodsAll longer term mental health units in Portugal providing on-site staffed support for at least 12 h per day were assessed with the Quality Indicator for Rehabilitative Care (QuIRC), a standardised tool completed by the unit manager. The QuIRC rates seven domains of care (Living Environment, Therapeutic Environment, Treatments and Interventions, Self/Management and Autonomy, Recovery Based Practice, Social Inclusion, and Human Rights). A random sample of service users were interviewed using standardised measures of autonomy, experiences of care and quality of life.ResultsMost (60 %) of the 42 units were in Lisbon and surrounding districts with 50 % based in the community and 50 % in hospital settings. They had a mean of 11.5 beds. Service users (n = 278) were mainly men (66.2 %), with a diagnosis of schizophrenia (72.7 %), and a mean age of 49.4 years. Community units scored higher than hospital units on the Living Environment, Treatments and Interventions, and Self-Management and Autonomy domains of the QuIRC. Increased service user age was negatively associated with all but one domain. All QuIRC domains were positively associated with service users’ autonomy and experiences of care.ConclusionsInvesting in better quality, community based mental health facilities is associated with better outcomes for service users who require longer term support.

Quality of care and its determinants in longer term mental health facilities across Europe; a cross-sectional analysis.

BackgroundThe Quality Indicator for Rehabilitative Care (QuIRC) is an international, standardised quality tool for the evaluation of mental health facilities that provide longer term care. Completed by the service manager, it comprises 145 items that assess seven domains of care: living environment; treatments and interventions; therapeutic environment; self-management and autonomy; social interface; human rights; and recovery based practice. We used the QuIRC to investigate associations between characteristics of longer term mental health facilities across Europe and the quality of care they delivered to service patients.MethodsQuIRC assessments were completed for 213 longer term mental health units in ten countries that were at various stages of deinstitutionalisation of their mental health services. Associations between QuIRC domain scores and unit descriptive variables were explored using simple and multiple linear regression that took into account clustering at the unit and country level.ResultsWe found wide variation in QuIRC domain scores between individual units, but across countries, fewer than a quarter scored below 50 % on any domains. The quality of care was higher in units that were smaller, of mixed sex, that had a defined expected maximum length of stay and in which not all patients were severely disabled.ConclusionsThis is the first time longer term mental health units across a number of European countries have been compared using a standardised measure. Further use of the QuIRC will allow greater understanding of the quality of care in these units across Europe and provide an opportunity to monitor pan-European quality standards of care for this vulnerable patient group.

Quality of Longer Term Mental Health Facilities in Europe: Validation of the Quality Indicator for Rehabilitative Care against Service Users’ Views

BackgroundThe Quality Indicator for Rehabilitative Care (QuIRC) is a staff rated, international toolkit that assesses care in longer term hospital and community based mental health facilities. The QuIRC was developed from review of the international literature, an international Delphi exercise with over 400 service users, practitioners, carers and advocates from ten European countries at different stages of deinstitutionalisation, and review of the care standards in these countries. It can be completed in under an hour by the facility manager and has robust content validity, acceptability and inter-rater reliability. In this study, we investigated the internal validity of the QuIRC. Our aim was to identify the QuIRC domains of care that independently predicted better service user experiences of care.MethodAt least 20 units providing longer term care for adults with severe mental illness were recruited in each of ten European countries. Service users completed standardised measures of their experiences of care, quality of life, autonomy and the unit’s therapeutic milieu. Unit managers completed the QuIRC. Multilevel modelling allowed analysis of associations between service user ratings as dependent variables with unit QuIRC domain ratings as independent variables.Results1750/2495 (70%) users and the managers of 213 units from across ten European countries participated. QuIRC ratings were positively associated with service users’ autonomy and experiences of care. Associations between QuIRC ratings and service users’ ratings of their quality of life and the unit’s therapeutic milieu were explained by service user characteristics (age, diagnosis and functioning). A hypothetical 10% increase in QuIRC rating resulted in a clinically meaningful improvement in autonomy.ConclusionsRatings of the quality of longer term mental health facilities made by service managers were positively associated with service users’ autonomy and experiences of care. Interventions that improve quality of care in these settings may promote service users’ autonomy.

Development of the Quality Indicator for Rehabilitative Care (QuIRC): reliability testing, factor analysis and service user assessment

Background/Objectives: To develop a toolkit (QuIRC) for assessing the living conditions, care and human rights of people with long term mental illness in psychiatric and social care facilities.

Development and use of the Quality Indicator for Rehabilitative Care (QUIRC) in Germany

Development and use of the Quality Indicator for Rehabilitative Care (QUIRC) in Germany

Quality of care in longer term mental health institutions in Poland

Background/Objectives: The „Development of a European Measure of Best Practice for People with Longer Term Mental Illness in Institutional Care“ (DEMoBinc) project was a collaboration between 11 centres in 10 European countries of varying levels of deinstitutionalisation and mental health service provision. This presentation aims to discuss the Polish experience in the development and implementation of the „Quality Indicator for Rehabilitative Care“ (QuIRC) and to provide a preliminary assessment of care standards in longer-term mental health institutions.

S38-01 - Quality of care and its determinants in rehabilitative mental health care across Europe

The European Commission's Green Paper on Mental Health highlighted the need to improve the social inclusion, human rights and dignity, of mentally ill people. It recognised evidence for improved quality of life and social inclusion provided by deinstitutionalization of services. This study, funded by the EC, explores the relationship between unit characteristics and quality of care, as recorded by the Quality Indicator for Rehabilitative Care (QuIRC).MethodQuIRC's seven domain scores were analyzed for associations with unit, patient and staff variables, using linear regression.ResultsUnit location affected Living Environment (LE) domain scores. Size of units was associated with all domains apart from Human Rights (HR). Resident characteristics showed single gender, percentage of lower functioning residents, both affected some domains. Staff intensity scores were not associated with any domain of care, but specific disciplines affected particular domain scores Lower quartile results across domains suggest that 25% of European units studied score less than 50% on individual domains’ quality scores.DiscussionResults suggest the preferability of residential rehabilitation units that are city-based, in the community, smaller in size, and have both men and women residents; where the proportions of detained patients, and patients with a high level of need, are low; and where the staff group includes an employment specialist and a psychologist, but does not include a social worker or a psychiatrist. Average unit performances for different countries in Europe need to be established and considered in developing preliminary quality targets to be reached in particular timescales.

S38-02 - International differences in the value for money provided by institutions in european countries at different stages of deinstitutionalisation and with different economies

BackgroundIndividuals with a diagnosis of schizophrenia or schizoaffective disorder may require longer term care. Due to the complexities of caring for this population and the high resource cost of care, it is important to ensure that mental health services are efficient and effective.AimsThis investigation aims to examine international differences in quality of care and service user experience when compared to national health expenditure and the degree of deinstitutionalisation in 10 countries.MethodsThe quality of care provided in 213 units was measured using the Quality Indicator for Rehabilitative Care (QuIRC). Service users living in these units (N = 1750) were asked to assess the care they received. Multilevel models were used to examine the relationships between quality (QuIRC domain ratings), level of deinstitutionalisation and national health care expenditure. As no formalised assessment of deinstitutionalisation has been published, a quantitative tool was developed and validated. Percentage of gross domestic product spent on health care and per capita total health care spend was taken from World Health Organisation data to assess national health care expenditure.ResultsMultilevel models examining the relationships between deinstitutionalisation levels, health care expenditure, quality and service user experience will be presented. Results were adjusted for unit (type and size) and service user (age, gender and level of functioning) characteristics.ConclusionsRecommendations on the best use of resources within a facility providing longer term care and how best to increase the quality of care provided without additional financial expenditure will be discussed in relation to the results.

S38-03 - Quality of care in longer term mental health institutions in Poland

ObjectiveDevelopment of Quality Indicator for Rehabilitative Care (QuIRC), experiences of Polish partner in implementation of the toolkit and preliminary assessment of care standards in longer term mental health institutions. Research constitutes a part of international project funded by European Commission.MethodsPolish version of QuIRC has been tested in 20 psychiatric units across 3 regions in Poland. Selected facilities differed in terms of employment profile, living standards as well as location and service users turnover. Managers of participating units were interviewed using the refined tool with 145 items regarding domains indentified during previous phases of the DEMoB.inc project. Each participant was questioned by a single researcher during face-to-face meeting. Lacking answers were completed on basis of service users’ medical files and account departments’ documents when necessary.ResultsManager of only 1 out of 21 units refused to participate in interview. The most common difficulties in data collection were in relation to the number of staff and staff training. These difficulties may be due to differences in the work patterns and training of staff in Polish units compared to other countries. In comparison to international results important differences in preliminary assessments of long term mental health care were found in several areas probably due to the early stage of deinstitutionalisation process in Eastern Europe. Development of the web based version of the toolkit will facilitate its implementation in research as well as internal assessments for units’ restructuring purposes.